Talk:Combined oral contraceptive pill/Archive 1

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Contents

Neutrality dispute

I do not think that this article sufficiently expounds on a criticism of oral contraceptives. Neither does it expound on any potential dangers of taking this contraceptive. Please express your opinions here. Bratschetalk 05:26, 13 February 2006 (UTC)

Can you be more specific? The sections "Effectiveness", "Drug interactions", "Side-effects", "Effects on sexuality", and "Cautions and contraindications" all discuss risks and dangers associated with oral contraceptives. If you think that this article lacks other, non-medical criticisms, feel free to add them. I don't think that not being all-inclusive justifies the "neutrality dispute" tag -- as far as I know, that tag is supposed to be reserved for situations where editors can't come to a consensus on what the most neutral way to phrase an article is. Catamorphism 05:31, 13 February 2006 (UTC)
Even if there are some side effect of pills, health risk of pregnancy far outweight such danger. Plus, you can stop taking pills and that is it. It's like comparing tobacco and other drugs. Sure, list "potential dangers". Just make sure that such dangers are properly attributed to particular case, individual or symptom. FWBOarticle

"more than one woman who experienced her first orgasm..."

"Masters and Johnson, among others, reported more than one woman who experienced her first orgasm during intercourse shortly after going on the Pill."

Surely this should read something like:

"Masters and Johnson, among others, reported more than one in four woman who experienced her first orgasm during intercourse shortly after going on the Pill"

I was under the impression they came across a handful of women who experienced this. I'm not sure how big their total interview/research group was, but I don't think they had enough 'first orgasm on pill' women to draw a statistically sound conclusion such as one in twenty.Lyrl 02:26, 26 February 2006 (UTC)

I agree it should be left vague. Especially because it's impossible to tell if that is a direct consequence of going on the pill, or if it is rather because going on the pill for the first time probably indicates a woman is in a stable, sexually active relationship for the first prolonged period.

Corporate Involvement

There's a substantial corporate history regarding which corporate entities have a vested interest in this market. Surely some of the major corporate players should be cited by name and date of involvement. Surprisingly, I just tried to find such a list, and the majority of my google queries come up with long lists of brand names not linked to the corporations behind them.

above entry added by User:24.68.159.182 16:31, 31 March 2006

Social consquences - "sexual revolution"

The final section just isn't particularly accurate.

There is no evidence other than anecdote that the pill caused a sexual revolution in the sixties, frankly there is no evidence of a sexual revolution in the sixties. Other than a revolution in the media.

I'm hoping to change this - but it does seem a big job and I am thinking how best to do it - any suggestions??

I agree with your assessment of the section. No specific suggestions, but I'll look at it when I have time. Also, when you post on the talk pages, if you put four tildes at the end ~ ~ ~ ~ (only no spaces), it will 'sign' your comment. Like this: Lyrl 00:06, 28 April 2006 (UTC)

Effectiveness

the effectiveness listed at 1 in 100 - where does that come from? [1] lists it as 5 in 100 with progestin-only pills, 1 in 1000 for 'combination pills', and 5 in 1000 for 'perfect use', of progestin pills, which implies that it perfect use is not very common. This planned parenthood page [2] is listing condom pregnancy rates at 14 per 100 for a year of use, 'only three will become pregnant if condoms are used perfectly'. Hmm. --MichaelTinkler

Can I just add - in the hope that someone will work this into the article - that the Pill is NOT a completely effective means of preventing pregnancy on its own. It also has no effect whatsoever against STIs, so while the Pill does mean that if you have unprotected sex (or an accident!) you are much less likely to get pregnant, condoms should also be used to provide full protection.--The Wizard of Magicland 21:38, 4 May 2006 (UTC)

I believe most of your concerns are currently addressed under the Effectiveness section. User effectivness is based only on users who use the method incorrectly or not at all. It has nothing to do with how many people use the method correctly or incorrectly. For the condom numbers, again remember the 14% failure per year number is only for users who use the method inconsistently or incorrectly. And while things like using oil-based lubricants or not pinching air out of the tip contribute to the user failure rate, most pregnancies amoung condoms users are caused by not using a condom.
Also, no birth control, not even combinations of multiple methods, not even sterilization, is 100% effective. Saying condoms used with the pill provide full protection is false.Lyrl 01:33, 5 May 2006 (UTC)
Surely user effectiveness is all users - otherwise it's a pretty useless stat: you could say 0.1% of couples put the condom on the end of a broom, but 90% of them get pregnant annually, we could user failure rates are 90%. Not very useful. --User:Taejo|대조 19:51, 19 February 2007 (UTC)

Lyrl-edits of 18 May 06

I am a medicinal chemist who deals in drug design and mechanism of action everyday. The information I put in is scientifically backed up with verifiable sources - five to be precise. The conclusions were not reached solely on the factor of STD's and if you would take the time to read the papers you would see that the conclusions do support the figures that I used. Albeit the lower end of the scale is most likely more accurate...that is not my right to determine but instead I need to use the reported, and peer reviewed data available. Further you do not source most of your "generally accepted" information. However, I do source everything I put in there. Your opinions do not belong here...this is a place for people to get information not be fed propaganda.

—Preceding unsigned comment added by Jdbrown1998 (talk • contribs) 15:06, 19 May 2006
This discussion seems to have reviewed the literature fairly thoroughly, and refers specifically to all the studies Jdbrown added as a references in support of extrauterine vs. intrauterine pregnancies being caused directly by combined oral contraceptives. It comments that "The letter by Job-Spira et al seems to represent the same data set of 279 cases and controls as the study by Coste et al." The meta-analysis by Mol apparently includes that study. So just one study is effectively being refered to three times; though the meta-analysis does include other studes which apparently (per edits by Davidruben) contradict the assertation of increased extrauterine pregnancy. The Polycarp Research Institute paper also discounts the WHO study as including women taking progesterine-only pills, which are commonly accepted as directly increasing the risk of extrauterine vs. intrauterine pregnancies. (In addition to that assumption in the Polycarp paper, a Google search for extrauterine pregnancy pill come up mostly with references to the mini-pill.)
While I unfortunately do not have access to the full text of these studies, I question how well STDs were controlled for. With study titles such as "Risk of chlamydial PID and oral contraceptives," STDs were obviously a factor in the ectopic pregnancies. Because women who choose to take COCs are more likely to engage in behavoir that puts them at risk of STDs, that population is going to have a higher ectopic pregnancy rate than the population of women who choose other forms of birth control. Not because of the hormones they are taking, but because of their behavoir.
The increased rate of ectopic pregnancy in COC users would seem to have an explanation in their increased STD rate, not in a postfertilization effect of the COCs. I would be very interested if someone with access to the studies explained how this confounding factor was taken into account when calculating the increased risk of extrauterine pregnancy due directly to COC use.Lyrl 22:19, 19 May 2006 (UTC)

OT question by younger user

--71.230.248.74 00:43, 31 May 2006 (UTC)OK, so my mom seems to think that taking this thing would be dangerous give me migranes, etc. There is the age factor (i'm 14) but still according to there commercial it reduces the amount of periods by 8 each year. Can someone get some statistics on the side effects maybe related to age that i could show her, or a list of all the pros and cons as stated by each side? Like a sort of summay of the article? Also, i seem to be getting the impresson that maybe she had a bad experience, so does genetcs contribtute to occurence of side effects? (sorry my keyboard is sticking today)--71.230.248.74 00:43, 31 May 2006 (UTC)

You're right that this is the wrong place, but you might want to look at the Planned Parenthood web site. It's generally a good source of reliable, objective medical information on contraception. Al 00:44, 31 May 2006 (UTC)

While we're talking about side effects, do we know why they occur? Some of them are similar to the symptoms of pregnancy and I was told by my mother (not a verifiable source by a long shot) that it was because the hormone increase was similiar that of pregnancy on a lesser scale (this was in a discussion about nausea, I've been rather ill riding in cars since I started a few days ago). Info like that could be helpful as many teens are coming here before PP for information... Kuronue 00:55, 3 June 2006 (UTC)

Estrogen and progesterone are both high during the luteal phase (time between ovulation and menstruation). They remain high during pregnancy. Many "pregnancy" symptoms are identical to PMS symptoms, and are caused by the high levels of estrogen and/or progesterone that occur both during the luteal phase and during pregnancy, rather than from any direct action of the embryo or fetus. As hormonal contraception consists of estrogen and progesterone, it is not surprising that it causes various PMS-like or pregnancy-like symptoms. I believe all women will have side effects from hormonal contraception; the type and severity of the effects varies widely between brands and between women. A few side effects, such as breast tenderness and nausea, tend to go away by the third month on the pill. As this information is all anecdotal from my experience and reading, I'm not sure it could be incorporated into the Wiki article - that generally requires sources. Lyrl 03:36, 3 June 2006 (UTC)
Most women don't get morning sickness or nausea during their periods; the first month or so on The Pill and the duration of pregnancy obviously cause nausea (I'm told it goes away wwhen you get used to The Pill). What I was asking was does anyone have a good source we can add to the encyclopedia from, since people like me might look for this kind of info and not check the antecdotal evidence on the talk page Kuronue 03:53, 3 June 2006 (UTC)

Oral contraceptive vs. Hormonal contraception

Hormonal contraception is currently a stub. But it seems like it should be a higher-level article than this one, since it encompasses all the delivery mechanisms of combined or progesterone-only contraception. And that this article should focus on the unique aspects of taking the hormones orally (such as "use" and "packaging") rather than on the actions of the hormones themselves. Would moving some of the sub-topics of this article (such as "principles," "mechanism of action," "effectiveness," "drug interactions," etc. to the hormonal contraception article? Lyrl 16:17, 10 June 2006 (UTC)

I agree. Fundamentally, whether you take it as a pill or through a patch or a ring, the key is that it's hormonal, so that should be the main article. At that point, oral contraceptive should either redirect to hormononal contraception, unles there is sufficient material to justify its existence. Al 23:55, 10 June 2006 (UTC)
  • Disagree (but with sympathy, and agreeing some changes to some of the articles is needed) - I agree as a discussion of categorisation this is correct, but:
  • Remember hormonal also includes injected progesterone (Depo Provera), and the coated 'coil' of IntraUterine System
  • I fear we risk fragmenting into too many pages. We already have as the top level, Birth control, which sets out the classification scheme and effectively bypass Hormonal contraception entirely (calling it 'Chemical methods')
    • Perhaps that 'Chemical methods' header needs to be reworded to Hormonal contraception
    • If Hormonal contraception is to discuss most of the effects of oestrogens & progesterones, it will be significantly larger than current Oral Contraceptive, as Progesterone only pill would also get included, along with Depo Provera, IUS and the various progesterone-implants.
    • Personally I would leave Hormonal contraception as a short descriptive/comparative piece with the greater details in the specific articles, or possibly just having a brief outline of the two groups of hormones and transfer this articles main history section there.
    • Oral contraceptive is current written mostly about the combined oestrogen & progesterone pill history, controversy, effects & side-effects (progesterone-only pills covers these topics it its own article). I would change this article to a redirection page to Combined Oral Contraceptive Pill and Progesterone Only Pill
    • Discussion of the risks of oestrogens (e.g. DVTs) really has no place in the main Hormonal contraception article in any great depth, as it is better suited to this article in discussing differences in risks of 2nd & 3rd generation COCP.
  • When it comes to how the reader might wish to browse & read through the various pages, having every possible level of the contraceptive classification with its own page will be a poorer experience. All my patients consider the options (amongst others) as 'the pill' (which includes both COCP & POP), 'the injection' and 'the coil' (meaning IUD & IUS). 'Hormonal contraception' whilst a technically correct term and one us contributing editors are familiar with, is not a phrase used by the general reader. Instead they will look for 'birth control' (or 'contraception') and then expect to jump to specific methods ('Hormonal', I guess, means little to the wider readership).

David Ruben Talk 00:41, 11 June 2006 (UTC)

Good point about hormonal contraception being so broad. That might actually need to be a disambiguation page instead of its own article. Maybe instead of hormonal contraception as a top-level article, there could be an article on Combined estrogen and progesterone contraceptive. Hmm. That's very ackward sounding. But it sure would be nice to combine the pill, patch, and NuvaRing pages somehow. And more fully seperate the combined pill page from the mini-pill page. Lyrl 17:26, 11 June 2006 (UTC)
Indeed these were my intensions (PS in UK, doctors do talk about COCP & POP or their expanded equivalents). Given that the Oral contraceptive would become the place readers might search out, it would then disambig to specific pages for COCP & POP, I think these should have the proper technical names (POP already exists of course, COCP currently redirects here). So:
I've just created Template:BirthControl, let me know what you think and then I shall add it to the various articles. David Ruben Talk 22:31, 11 June 2006 (UTC)

That all sounds good. On the template, coitus interruptus is considered a form of masturbation by the Catholic Church, and is not part of NFP. Everything else I really like. Lyrl 00:09, 12 June 2006 (UTC)

Ah... Need alternative heading then in the templates 1st line, How about 'Natural' (meaning as opposed to products or medical). 'Self-administered' or 'User' seem awkward. 'Non-medical' might then imply Condoms are medical, which clearly they are not. David Ruben Talk 01:50, 12 June 2006 (UTC)
I've copied last 2 postings across to Template talk:BirthControl, where perhaps more relevant to discuss further :-) David Ruben Talk 02:05, 12 June 2006 (UTC)

Beginning of pregnancy controversy - implantation vs. fertilization, in vitro

The medical consensus is that pregnancy starts with implantation, not fertilization. This definition of pregnancy did not start until the advent of in vitro fertilization — having eggs fertilized in a laboratory is not generally accepted to make a woman pregnant. Many sources do still define pregnancy as beginning with fertilization. Therefore, the determination of whether oral contraceptives are abortificants depends largely on a person's individual definition of pregnancy.

This paragraph probably needs to be rewritten. For starters, the beginning of pregnancy controversy mentions in vitro fertilisation but doesn't say it was the cause of pregnancy being defined as beginning at implantation. It doesn't discuss when and why there was a change, if there was a change (and it wasn't just a pre-existing but probably largely ignored difference in terminology). Secondly the 'many sources' part is a bit of a weasel word IMHO in this context. How many is many? It would be better to say some medical sources or something of that sort maybe. Finally, the bit about "determination of oral... depends..... person's invididual...." is a bit confusing. This article already establishs that no one really know whether oral contraceptives do interfer in implantation. If they don't personal believes on the beginning of pregnancy is irrelevant to the issue at hand. Nil Einne 12:42, 17 June 2006 (UTC)

Well I decided just to be bold. My new paragraph is as below

The medical consensus is that pregnancy starts with implantation, not fertilization. However some medical sources do still define pregnancy as beginning with fertilization. Therefore, if oral contraceptives do interfer with implantation, the determination of whether oral contraceptives are abortificants depends largely on a person's individual definition of pregnancy. See Beginning of pregnancy controversy for more information

As you can see, I removed the unsourced bit about the origins of the definition, I've changed the weasel word many and I've made it clear the issue is only relevant ir oral contraceptives do interfer with implanation which we don't know. See my discussion above for more info on why I made my changes. I also added a link to the beginning of pregancy controversy since it should be the primary article. I'm not particularly good at style so maybe it should be mentioned in a different way but at least it's mentioned Nil Einne 12:45, 17 June 2006 (UTC)

Safety of pills vs. pregnancy

A common example is blood clots. Women on combined hormonal contraceptives are at increased risk of blood clots compared to non-pregnant women not using the drugs (3-6 per 30,000 for pill users vs. 1 per 30000 for non-pregnant non-pill users). However, pills protect from pregnancy and the much higher risk of blood clots associated with pregnancy (30 per 30,000). [3]

These facts have been verified by multiple studies, and I have no problem say knowledge of them is "commonly held" in the medical community. Lyrl Talk Contribs 12:53, 23 July 2006 (UTC)

Okay, so there is absolutely NO WAY in which pregnancy is safer than the pill? No area? I really think that this is false...but I don't know for sure.

Chooserr 16:08, 23 July 2006 (UTC)

Pregnancy is dangerous. Increased risk not only of blood clots, but of aneurysms and strokes. It does permanent damage to the pelvic floor, risk of gestational diabetes (which can turn into permanent diabetes), pre-eclampsia and HELLP syndrome... I can keep going if you want.
Pregnancy does provide long-term protection from breast and ovarian cancer - but I've never seen anyone say a woman should get pregnant for the sole reason of protecting herself from those two forms of cancer. Lyrl Talk Contribs 18:15, 23 July 2006 (UTC)
Do you have a source for the protection from breast cancer statement? Because pregnancy increases hormones and hormones increase risk-- or is that totally outdated? IMFromKathlene 03:56, 31 August 2006 (UTC)
On ovarian cancer, a woman who has her last child when older than 35 decreases her risk of ovarian cancer by about 50% [4].
On breast cancer, a recent study in Nigeria found that delaying first pregnancy until after 20 years of age increases a woman's risk of breast cancer by 32% [5]. This one from Italy [6] seems to say that having a first child after 30 versus at younger than 20 increases breast cancer risk by 431% (odds ratio 5.31, that's 431%, right?)
Increased hormones are not the only changes that occur during pregnancy - this article [7] explains some of the theories about why pregnancy protects from breast cancer. Lyrl Talk Contribs 00:56, 1 September 2006 (UTC)

Why was this statement (In general, the health risks of oral contraceptives are far lower than those from pregnancy and birth) removed in recent edits? Inappropriate comparison or not, it is a high-visibility claim made by the medical community and drug manufacturers that deserves to be addressed in this article. Lyrl Talk Contribs 23:15, 7 September 2006 (UTC)

...1) we could compare any method of bc to pregnancy; it's not unique to the pill. 2) it posits pregnancy only as "unwanted pregnancy"--in a wanted pregnancy, women get something out of pregnancy they don't get out of bc--in a risk/benefit calculation, women make different calculations for bc and pregnancy. 3. pregnancy is sui generis--we could compare two forms of bc, but what is comparable to pregnancy?

i think the whole comparison of pregnancy/the pill is weirdly selectively contructed/a logical fallacy. two things which are on par/alike can be compared. (there's a whole discussion viz abortion and appropriate comparisons--an appropriate comparison was determined to be: two forms of abortion available at 8 weeks gestation. comparing one form of abortion at 8wks gestation to forms of abortion at later gestation, pregnancy, and other drugs was stricken.) Cindery 23:31, 7 September 2006 (UTC)

Those points can certainly be discussed in the article. But the comparison was in my pill inserts, has been made by doctors on this site, is on numerous websites that discuss the safely of hormonal contraceptives, and is in the very popular book originally used as a source by this article. It is a high-visibility statement that should be addressed. Lyrl Talk Contribs 22:13, 8 September 2006 (UTC)

elevating the comparison of the pill to pregnancy to the status of a high-visibility controversy is not supported by any evidence i have seen...controversies should be selectively reported on in accordance to their importance. ( the important controversy that has been excluded if any i think is the controversy re cancer risk v. the pill-- doctors are taught in medical school that in a risk/benefit analysis, the benefits outweigh the risks/feminist orgs like the national women's health network counter that the risk/benefit analysis concept was developed to analyze drugs with serious side effects which are given to sick people, not drugs given long-term to perfectly healthy people.) but that's a separate topic. i don't think pill/pregnancy is a high-visibility statement, i think it's just a claim that's been bandied about. not unlike: the pill is revolutionary! etc. not every statement that's ever been made about the pill can be included here and analyzed in depth--it's already a sprawling piece. comparison between pregnancy and <fill in the blank> birth control method are not standard on wikipedia... Cindery 22:43, 8 September 2006 (UTC)

Pill-related polution and human male fertility

It seems there has been some speculation that the pollution of drinking water with synthetic estrogen is affecting human male fertility. However, there appears to have been no research to support this speculation, and even serious discussions of declining male fertility (like here) dismiss the pill hormone-male fertility theory as "extreme." Lyrl Talk Contribs 18:30, 23 July 2006 (UTC)

I didn't see them adress the pill hormone-male fertility theory, only the laptop theory, and it even said that it was possible. It just said that something else at work BESIDES the laptop theory is at work. So I wouldn't go saying that this is extreme.

I'm currently searching for more information about the pill hormone-male fertility theory, and will (god willing) come back with some more information.

Chooserr 19:01, 23 July 2006 (UTC)

Hmmm...I found a rather interesting summary just after posting that, which while not concerning synthetic estrogen from the Pill talks about its effect in general, and highlights some chemicals which cause it (including DDT) - its here if you want to have a look. Maybe this deserves its own article? Chooserr 19:10, 23 July 2006 (UTC)


Well I found some other links but they can hardly be considered more reliable (one is from Jivemagazine). None of them are really from the study. But I'll give it another look. Chooserr 19:59, 27 July 2006 (UTC)

Source Problems

Sources 7 & 8 listed in this article do not appear to be in the correct place. The article referenced in source 7, http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=4052920 , only claims an increase in ectopic pregnancy for IUD users, not oral contraceptive users (which it did not find any significant change to). Source 8 has two problems: first, its link does not directly link to the article; a second link must be followed. Secondly, the article, at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=2293688&itool=pubmed_Abstract , does not deal with ectopic pregnancies at all; indeed, it appears the risk for PID (a risk factor for ectopic pregnancy) is reduced by using the Pill. --Chiapr 15:37, 24 July 2006 (UTC)

I had other problems with that whole section when it was put in (see discussion section #Lyrl-edits of 18 May 06), but I didn't want to get into a revert war at the time and then forgot about it. If you want to clean that section up, please do. Lyrl Talk Contribs 21:29, 24 July 2006 (UTC)

Removed paragraph - "'married women'... 'indisputable effectiveness'"

"Further, married women had control over their family size, even if their belief was that the woman was obligated to submit to her husband's sexual desires — regardless of her interest — which had been a prevailing view in many cultures. For women with abusive husbands or women who had had high risk pregnancies, this control was potentially lifesaving; however, it did lead to the conflict of obtaining medication without fully informing the husband.

In time, however, as society adjusted to these new facts, the Pill largely regained its reputation, due to its indisputable effectiveness and convenience. According to some sources, 80 percent of American women use the Pill at some point in their lives.[citation needed]"

this is ungrammatical and makes no sense in a number of places, but i think some of the ideas may be worth saving/rephrasing.

for example, i don't see how the pill could be lifesaving for a woman with an abusive husband. ? or how the pill could be lifesaving in a high-risk pregnancy. (access to contraception could prevent a high-risk pregnancy in a woman likely to have one due to health conditions, but the pill itself has no effect on a high risk pregnancy...)

also, i'm not sure that the pill "regained its reputation"--the WHO/IARC recently upgraded it from a possible carcinogen to definitely carcinogenic to humans. it *is* certainly popular, but its reputation viz breast cancer shouldn't be treated as though all concern is gone. and a claim of %80 is rather high (and would need a source other than ortho-tricyclen, even if that link worked...) Cindery 03:00, 5 September 2006 (UTC)

Breast enlargement via the pill

I see that the statement about women going on the pill to increase their breast size has been marked as needing references. I have no doubt that this is true. If you search various internet forums you can certainly find this subject being discussed. What is more relevant is the fact that it doesn't necessarily work. In particular, low-estrogen pills often cause breast volume reduction due to their progestin content. It'd be nice if we could find some reliable statistics on that. -- Kiral 10:03, 5 September 2006 (UTC)

it's specifically the statement "many women..." that needs a citation, i think. a source. a survey or study. some numbers. but you're right that it needs citations in general, if it's going to be mentioned included. (*does* it need to be included? if so, maybe it should be in side effects? "pill can sometimes increase or decrease breast size" etc? Cindery 16:57, 5 September 2006 (UTC)


Effects on sexuality

The effect of the Pill on a woman’s sexuality are difficult to judge; depending on the individual and the particular formula, the Pill may enhance or disrupt a woman’s (or couple’s) sex life. Because neither the woman (who uses the Pill) nor her partner need take any special action before or during intercourse, it makes birth control "invisible" and sex spontaneous, more natural, or both. When combined with the Pill’s high degree of effectiveness, this may enable the couple, and especially the woman, to relax more easily during sex. Masters and Johnson, among others, reported more than one woman who experienced her first orgasm during intercourse shortly after going on the Pill.

On the other hand, the Pill’s various side effects may prove disruptive on a physiological or even a psychological level. The hormonal disruption caused by the Pill may result in mood swings, lower libido, excessive or insufficient vaginal lubrication during intercourse, and possibly an injured self-image due to weight gain. Some women who use the Pill despite the teachings of their religious traditions may feel conscious or unconscious guilt; others may not fully trust an "invisible" method of birth control. This wide range of variables makes prediction of the Pill's effect on sexuality difficult, but the fact that the Pill can and does have an impact in this area, for good or for ill, is well-documented.

...i moved this here for now because it doesn't cite a single ref. no doubt some of these assertions are valuable and can be backed up, but the style is editorial/subjective in addition to citing no refs. whole thing should be rewritten/restyled/sourced. Cindery 20:34, 7 September 2006 (UTC)

Side effects

I was wondering about the rate of weight gain and weight loss. It says 50% for both, but I don't think that can be correct. I found a source saying that about 40% of women report side effects - meaning that 60% don't. And 50% can't report weight gain if 60% report nothing.

Also, I think the side effects section should be expanded with some percentages and actual numbers. Fresheneesz 20:51, 11 September 2006 (UTC)

I imagine the prevalence of side effects is largely dependent on what is categorized as a side effect, how the questions are asked, and when they is asked. I can't tell you how many posts I've seen from women who quit bcp and were amazed at how much less moody, more happy, and more interested in sex they were. But these effects often begin gradually and are not immediately noticed to be caused by the hormones. If these women were interviewed while they were still taking the drugs, they would not have known they were experiencing side effects.
Also realize that many women quit because of side effects. If a side effect study is done on women who have been taking the pill for a year, for example, the ones experiencing major side effects will not show up - because they are no longer taking the hormones.
Fresheneesz's idea for expansion sounds good. I'd be happy to see more information and citations in that section. Lyrl Talk Contribs 23:52, 11 September 2006 (UTC)
Interesting perspective. I have no experience in that, but if you can source that information, I think it would be a good addition to that section. Especially on the gradual onset of side effects. Fresheneesz 03:37, 12 September 2006 (UTC)
Most of my information is anecdotal. I'd be starting at square one with research for verifiable information to put in the Wikipedia article. I did a search today and found this article on the pill and depression (it references this research study). Lyrl Talk Contribs 23:29, 12 September 2006 (UTC)

Extrauterine pregnancies

Source problem: "The theory that the pill has postfertilization effects is also based on some studies that found the ratio of extrauterine to intrauterine ratio of pregnancies increases by 70–1390% in women using the pill". 13,14 and 15 is listed as sources, but none of them (14 was a comment/letter that was not available) seems to reach the conclusion stated in this sentence. The article listed as source nr 13 ("A multinational case-control study of ectopic pregnancy...") in fact states that there was NO connection between XU-pregancies and OC. Number 15 ("Risk factors for ectopic pregnancy: a case-control study in France, with special focus on infectious factors.") states some connection between contraceptives, but does not discriminate between IUD and OC- which of course makes a huge difference in this context. -J-

See #Lyrl-edits of 18 May 06 and #Source Problems for prior discussion. I would be happy to see cleanup of that section. Lyrl Talk Contribs 13:00, 28 September 2006 (UTC)

Djerassi is Austrian, not Bulgarian

The "History" section says: "Carl Djerassi, a young Bulgarian chemist, [...]. Djerassi was born in Vienna, Austria in 1923. While escaping Nazi persecution, he spent 2 years in Bulgaria (1939-1941) before fleeing to the United States. Djerassi is Austrian, not Bulgarian.—Preceding unsigned comment added by AdderUser (talk • contribs)

Djerassi is American. His Viennese mother and Bulgarian father met in medical school at the University of Vienna, married and moved to Sofia, Bulgaria. His mother returned to Vienna for two months for the birth of her only child. Djerassi lived in Bulgaria with his parents until he was five. He and his mother then moved to Vienna where he attended a Realgymnasium until age fourteen, spending summers in Bulgaria with his father who had divorced his mother. After the Anschluss, his father briefly remarried his mother to allow Djerassi to escape to Bulgaria in 1938 where he lived with his father for a year attending the American College of Sofia while his mother went to England to await a visa to emigrate to the United States. At age sixteen, Djerassi and his mother arrived nearly penniless (they had only $20) in the United States in 1939. Djerassi married his first (American) wife in 1943 before beginning graduate study at the University of Wisconsin-Madison where he earned his Ph.D. and became an American citizen in 1945. He worked for Ciba the year before and four years after his graduate studies. In 1949, he was recruited to be the associate director of research at Syntex in Mexico City by then technical director George Rosenkranz, and worked there from 1950-1951 and again from 1957-1960 (while on a leave of absence from Wayne State University before moving to Stanford University).
68.253.191.144 16:03, 19 October 2006 (UTC)
Thank you. I have moved this info to the Carl Djerassi page. You might wish to make further edits and quote sources.--Grahamec 22:58, 19 October 2006 (UTC)

Thank you for moving the info to the Carl Djerassi page. The information was from his two autobiographies (Steroids Made It Possible and The Pill, Pygmy Chimps, and Degas' Horse).69.208.208.210 03:55, 20 October 2006 (UTC)

I also thank you for the info. And for the purposes of the main Oral Contraceptive article, I think leaving out the "young [pick a country]ian chemist" part is a good choice.AdderUser 01:26, 23 October 2006 (UTC)

Needed: How oral contraceptives suppress ovulation

Hi. Ne'er posted anything on the talk pages before, so excuse my possibly incorrect formatting. I find this article to be generally lacking the information one might seek here, but I lack the confidence in my knowledge to add any large sections.

My main criticism is the severe lack of information in the 'Mechanism of Action' section, which merely states 'prevents ovulation'. While this may be sufficient for readers glossing the page over, or teens looking to be informed, it is simply not enough for this article. If one examines pages for any other pharmaceutical in use by a large percentage of the population, the main section is dedicated to what the drug actually does. The section in this article could at least mention the pill's negative feedback effect, the abscense of a LH spike, and the differences between POPs and ones that also contain estrogen. A quick and easy explanation of exactly why placebos are included could also be slotted in. The Menstrual Cycle is a featured article, it could at least use a link in Mechanism of action, and at the top of the page, in addition to the one in the Use section. Any thoughts? 68.147.180.89 08:37, 16 November 2006 (UTC)

Sounds like a good idea, though I don't have the knowledge to contribute. I would encourage you to use references (enclose them in <ref></ref> tags will appear in the Footnotes section near the end of the article). And also realize there is some tension between this page being a top-level article, vs. covering only combined oral contraceptives with Hormonal contraception being the top-level article. This information might be better put in the hormonal contraceptives article. Lyrl Talk Contribs 00:06, 17 November 2006 (UTC)
Hmm. Checked out this Hormonal Contraceptive article, it didn't carry the information either. I'll try to find a couple decent references to add what I was talking about.68.147.180.89 02:47, 19 November 2006 (UTC)

This article definitely needs more info on the mechanisms of action!!! Horia 00:19, 24 April 2007 (UTC)

I added information on how combined oral contraceptives prevent ovulation.
BC07 04:55, 16 July 2007 (UTC)

Postfertilization effects

It also seems to me that the aricle is intentionally deceptive on this point. In all of the medical information websites I found on the web, one of the mechanisms for all forms of the pill was described along the lines of, "The lining of the uterus is also affected in a way that prevents fertilized eggs from implanting into the wall of the uterus," or, "It alters the endometrial lining, inhibiting implantation of a fertilized egg, if ovulation has occurred," or "Both pills also prevent the lining of the uterus from thickening, which means that a fertilized egg is unable to implant itself in the lining and grow". However, this article is presenting information within the mechanisms section as if this particular mechanism is in some serious dispute. Granted, for some forms of the pil the prevailing mehanism was the prevention of ovulation, the alteration of the endometrial lining in those pills still serves the preventative effect of impeding implantation should both ovulation and fertilization have occured. I entered a sentence to clarify this point. Is the endometrial lining mechanism really in serious debate in the medical field? Brad 19:17, 16 December 2006 (UTC)

It was believed a few decades ago that the IUD worked 100% by preventing embryo implantation, that their effect on the endometrium was the only mechanism by which hormonal emergency contraceptives worked, and that all hormonal contraceptives prevented implantation. But studies have now proven that the IUD is highly spermicidal and that this anti-fertilization effect is its primary mechanism of action, that even one dose of hormones as emergency contraception prevents ovulation frequently enough to account for the effectiveness of such regimens, and that the research about any anti-implantation effect of ongoing hormonal contraception is seriously lacking.
All of the evidence for the anti-implantation effect is presented in the controversy section. If another editor has other evidence not presented, or believes the current evidence is presented in a POV way, then please modify. But there is not currently evidence to say for sure that hormonal contraception actually has any effect on implantation rates (or, conversely, that it does not have an effect). Lyrl Talk Contribs 19:56, 16 December 2006 (UTC)
I noted the following study results after a brief search:

The primary mechanism of oral contraceptives is to inhibit ovulation, but this mechanism is not always operative. When breakthrough ovulation occurs, then secondary mechanisms operate to prevent clinically recognized pregnancy. These secondary mechanisms may occur either before or after fertilization. Postfertilization effects would be problematic for some patients, who may desire information about this possibility. This article evaluates the available evidence for the postfertilization effects of oral contraceptives and concludes that good evidence exists to support the hypothesis that the effectiveness of oral contraceptives depends to some degree on postfertilization effects. However, there are insufficient data to quantitate the relative contribution of postfertilization effects. Despite the lack of quantitative data, the principles of informed consent suggest that patients who may object to any postfertilization loss should be made aware of this information so that they can give fully informed consent for the use of oral contraceptives.

Based on this,I have re-inserted the cautionary description in the methods section to the affect that this is a recognized secondary mechanism - it is important that people concerned about whether the pill interferes with implantation understand these study results are out there.

Brad 17:26, 23 December 2006 (UTC)

The Larimore and Standford article quoted by Brad seems to be a comprehensive review of current knowledge on the subject. I've rewritten the "controversy" section (retitled "postfertilization effects") to heavily reference it. However, that is only one paper by two people. As far as serious research on the question of postfertilization effects, we seem to have Larimore and Standford in the yes-they-exist camp, and the American Association of Pro-Life Obstetricians and Gynecologists in the still-unproven camp. And no one else doing research, just a bunch of repeating speculation that originated in the 1960s. I don't know that the sources presented so far show a medical consensus for either position, though I would be interested in seeing any such sources others are aware of or find.
  • The Larimore & Stanford article is not "a comprehensive review of current knowledge on the subject."
  • The Larimore & Stanford article is "only one paper by two" Christian pro-life family practice physicians with no special expertise on hormonal contraception that, while acknowledging that inhibition of ovulation is the primary mechanism of action, argue that, by their interpretation of some studies, good evidence exists to support the hypothesis that the effectiveness of oral contraceptives depends to some unquantified degree on postfertilization effects.
  • Other Christian pro-life physicians, including board members of the American Association of Pro Life Obstetricians and Gynecologists (Crockett et al.) and a young Earth creationist Cedarville University professor of biology (Sullivan), who are more than ready to believe that other contraceptives (including some hormonal contraceptives) have postfertilization effects, disagree with Larimore & Stanford's interpretation of studies and argue that there is no evidence that the effectiveness of COCPs depends on postfertilization effects.
  • Neither Larimore & Stanford, nor the American Association of Pro-Life Obstetricians and Gynecologists, are doing "serious research" on the mechanism of action of hormonal contraceptives.
  • Research on the mechanism of action of hormonal contraceptives has and is being done by the developers of hormonal contraceptives, by experts on mammalian gamete and embryo transport (e.g. reproductive physiologist Croxatto et al.), and related research has and is being done by developers of assisted reproductive technology.
BC07 04:55, 16 July 2007 (UTC)
My only critisism of Larimore and Standford is their presentation of the intrauterine vs. extrauterine pregnancy ratios. While they document their sources meticulously, and note where the same study is published in more than one place (so they don't count the same study multiple times), the articles they reference distressingly do not support their claims. The WHO study and the meta-analysis they cite actually found no increased risk related to oral contraceptives, even with the pregnant controls. And the study that found the biggest risk increase was confounded by not including women seeking abortions - but that information is completely absent from the Larimore and Standford analysis. Lyrl Talk Contribs 23:13, 23 December 2006 (UTC)
  • An article like that of Larimore & Stanford who "document their sources meticulously"—so they can and do use the same study multiple times—and whose sources "distressingly do not support their claims"—is not a reliable source for an encyclopedia article, much less one that should be "heavily referenced" as the primary source for a major section of an encyclopedia article.
BC07 04:55, 16 July 2007 (UTC)

A good RECENT (September 2006) overview of this controversy can be found here: http://www.asa3.org/ASA/PSCF/2006/PSCF9-06Sullivan.pdf Dennis Sullivan comes from the perspective that there are valid ethical questions, but that the liklihood of a COC-induced abortion is so statistically small as to be almost negligible. I did not have time to post any references to it in the main article, but I think it may be very useful. The weakness of Sullivan is that he is entirely focused on COC's, and although he admits that the abortifacient mechanism in POP's is inherently more plausbile, it is not the intent of his article to examine them, only COC's. Brad 23:55, 23 December 2006 (UTC)

Additionally, I am not sure why the purely philosophical debate about when pregnancy actually begins necessarily needs to be conflated with genuinely medical debate about whether or not oral contraceptives actually inhibit the implantation of a fertilized egg. Does anyone else feel the need to keep these two debates separate in the sections of the main article - both are of value on the subject, but it seems wrong to me to lump them together. Brad 00:02, 24 December 2006 (UTC)

Researcher's political beliefs on abortion seem to influence their opinions on postfertilization effects. Pro-choice researchers have a tendency to deem such effects 'likely' if they seem theoretically plausible, while pro-life researchers have a tendency to demand evidence for effects that are disturbing to them. However, the section is not currently written in a "be aware of biases" way so I see where it could be more distracting than helpful where it is in the article. I'm hesitant to give a four-sentence paragraph with no expansion potential (as it's a summary of another article) its very own section. But I'll go along with the flow if Brad and/or others feel the article would read better with the political stuff sectioned off. Lyrl Talk Contribs 00:21, 24 December 2006 (UTC)

The current wording I think approaches a good NPOV feel; however, the often opinionated debate surrounding the "when does pregnancy begin" question, with its (necessary) moral and religious overtones, seems to me to somewhat undermine the legitimacy of the scientific question of whether implantation is detrimentally affected, when the two are combined as a single section. Perhaps I am being too subjective. Brad 21:05, 25 December 2006 (UTC)

Proportion of women using oral contraceptives

There is no information included in the article about the proportion of women taking the birth control pill. I would believe that statistics to this effect would be important in understanding the social and cultural aspects of birth control. Nealc9999 05:13, 29 November 2006 (UTC)

The information is limited, but there is some there. From the very first paragraph in the article: usage prevalence varies: one quarter of reproductive age women in the United Kingdom take the pill,[1] but only 1% of women in Japan.[2] If you're interested in the topic, I would encourage you to do the research needed to create a section on "Prevalence" or equivalent. Lyrl Talk Contribs 23:43, 29 November 2006 (UTC)

Inclusion of Ormeloxifene/Centchroman - an oral contraceptive

The following represents a decently-sized monkey wrench.

Currently, this article describes oral contraceptives as unilaterally hormonal. However, there exists a non-hormonal oral contraceptive called Ormeloxifene, a.k.a. Centchroman. It is not hormonal, it is a selective estrogen receptor modulator, in the same class of medications as tamoxifen. Ormeloxifene has been used in India as birth control for over 15 years. I want to incorporate ormeloxifene appropriately into this article, as it is an oral contraceptive.

Conceivably, one could identify those instances in this article where oral contraceptives are referred to as always hormonal, and to change the phrasing in those instances to refer to them as "hormonal oral contraceptives". Then, a section on ormeloxifene could be added. However, the current article is entirely written in regards to hormonal oral contraceptives; describing their mechanism of action, formulations, effectiveness, side effects, packaging, social and environmental impact, and so forth. Changing all of this to be inclusive in its language of ormeloxifene would be very labor-intensive.

Another option would be to split the content within the article, with a top-level header for "hormonal oral contraceptives" and another header at the same level for "ormeloxifene". However, this presents the same problem of combing through the existing content to find and change references to oral contraceptives as necessarily hormonal.

My thought is that it might be simplest to move the bulk of this article to the location of hormonal oral contraceptive, and to make oral contraceptive a disambiguation page between hormonal oral contraceptive and ormeloxifene, as they are both oral contraceptives. I realize that people may feel hesitant to do this, but the advantage of doing it this way this would be that it would be much less labor-intensive in terms of properly editing the oral contraceptive article to be inclusive of all forms of oral contraceptives. What do you think? Joie de Vivre 21:23, 16 December 2006 (UTC)

I would tend to be even more specific, the current article is almost exclusively about Combined Oral Contraceptive Pill (COCP) and should be largely moved there. This Oral contraceptive page then perhaps just sets out the history of the COCP, Progesterone Only Pill (POP - should be renamed as Progestagen Only Pill, rather than US-centric Progestin Only Pill) and, not unreasonably, a small mention also of ormeloxifene (small only in as much that only used in a single country). Combined Oral Contraceptive Pill would have details on the specific details, formulations and side-effect of the class of drugs.
This would give the following Heirachy of articles:


                     Birth control                  
                           |
    +----------------------+-----------------+----...others
    |                      |                 |
Oral contraceptive   Hormonal contraceptive  |
    |                      |                 |
    +----------+----+      |                 |
    |          |    |      |                 |
    |          +----+----+-+--+-------+      |
    |          |    |    |    |       |      |
ormeloxifene COCP  POP Depo Implanon IUS    IUD     etc David Ruben  Talk  00:58, 17 December 2006 (UTC)


Thank you for your support. I agree that the content of this article does not belong under hormonal oral contraceptive, as I had originally proposed, but that it would better fit under Combined Oral Contraceptive Pill. -- Joie de Vivre 23:21, 17 December 2006 (UTC)
The following discussion is an archived debate of the proposal. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

The result of the debate was move —Mets501 (talk) 02:17, 27 December 2006 (UTC)

Requested move

Oral contraceptive → Combined oral contraceptive pill — There are three main types of oral contraceptive; the Combined oral contraceptive pill (COCP), the progestogen only pill (POP), and ormeloxifene. The current content of Oral contraceptive focuses exclusively on one type, the COCP, with a prominent infobox and extensive information about the COCP. There are only a few words on the POP, and no mention of ormeloxifene. The POP has its own well-written article, as does ormeloxifene. Moving the content about the COCP to the page with that title will allow for disambiguation of all oral contraceptives at Oral contraceptive, with links to each type's own page. Joie de Vivre 14:03, 21 December 2006 (UTC)

NOTE: Apparently, Lyrl went ahead and moved the content after this notice had been up for about a day and a half. I was not anticipating this, nor was I aware that this had been done until I discovered it. Since it is the holidays and many people may not have had a chance to speak their piece, this notice will remain up until well after the New Year. Support, opposition, or comments remain welcome. Joie de Vivre 18:55, 24 December 2006 (UTC)

Survey

Add  # '''Support'''  or  # '''Oppose'''  on a new line in the appropriate section followed by a brief explanation, then sign your opinion using ~~~~.

Survey - Support votes

Support - I proposed something similar several months ago (here). Lyrl Talk Contribs 02:41, 22 December 2006 (UTC)

This makes a lot of sense, and gives the subject much more clarity. Brad 20:54, 25 December 2006 (UTC)

Survey - Oppose votes

Discussion

What about male oral contraceptives? Would those be linked to also? Lyrl Talk Contribs 02:41, 22 December 2006 (UTC)

I don't see any reason why not. Joie de Vivre 13:15, 22 December 2006 (UTC)
The above discussion is preserved as an archive of the debate. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

Move of Oral Contraceptive contents to "Combined oral contraceptive pill"

This is intended to be a space where people can discuss this change, if necessary. Although of course I support my own suggestion, I wasn't aware that others would take such quick action to make the move: I suggested this move on the 21st. Lyrl surprised me by making the move on the 23rd, and then Mets501 closed the debate on the 27th. It is possible that some people might have been on vacation or busy with their families during Christmas. If anyone feels they were not given enough time to voice their opinion, please feel free to do so, here. 18:20, 27 December 2006 (UTC)

"Pregnancy rate" rather than "failure rate"

Note discussion at Talk:Birth control#"pregnancy rate" rather than "failure rate" re replacing occurrences of "failure rate" with "pregnancy rate". I would also like to see the same change on this page. Please make any comments there. --Coppertwig 04:04, 8 January 2007 (UTC)

Mayo Clinic Proceedings

69.208.173.236's edits are confusing. He changed the statistics, deleted a whole paragraph, and added several adjectives which together sound anything but encyclopaedic. I think it should be reverted, but every time I revert I get reverted so I'll post it here. Chooserr 01:46, 10 January 2007 (UTC)

Thanks Chooserr, i agree other version less clearly written for an encyclopaedia (this is not a scientific journal reported statistics with all due technical jargon). Could you have a look though at some changes I made as full access to the Mayo Clinic report is not currently freely available (will be 6 months after Oct'06):
  • I changed the link from the organisation's homepage to their webpage on COCP & Breast Cancer.
  • That web page was from 2003 when 18 of 21 studies so concluded incr risk (i.e. not "21 of 23")
  • The latest 2006 paper is not directely available from the org's site, but rather it links to the Mayo Clinic Proceedings homwpage.
  • I've therefore added a citation ref for this Oct'06 Mayo Clinic Proceedings paper, via PubMed search.
  • Without access to that full paper, I remain confused re "21 of 23" as this is neither the number in the 2003 assessment, nor that implied in the abstract of the Oct'06 paper which states 34 (from memory) papers meeting inclusion criteria for the meta-analysis.
That all said is this paper and the additional paragraph that helpful to the article, as the conclusions seem to me to be identical to that in the preceeding paragraph (i.e. that there is an increased risk, more so for pre-1st pregnancy use, and finally that the additional risk dissipates 10years after discontinuation) ? David Ruben Talk 04:07, 10 January 2007 (UTC)

Percy Lavon Julian

I don't want to diminish his contribution but he made a batch of synthesized progesterone from sterols, which was not on the path to the BCP. It was Syntex and Upjohn that made the estrogen analogues that comprise the BCP. --Richard Arthur Norton (1958- ) 21:07, 7 February 2007 (UTC)

I have removed this: "In 1940, Percy Lavon Julian's research at Glidden Co.,Chicago,USA took on a new direction when he began work on synthesizing sex steroids: progesterone (a female hormone), estrogen, testosterone (a male hormone), from plant sterols such as stigmasterol, isolated from soybean oil by a "foam" technique he invented. His work made possible the production of these hormones on a large industrial scale, thereby reducing the cost of treating hormonal deficiencies, arthritis, and other disorders and setting the stage for future developments in reproductive research. NOVA - Forgotten Genius"

Mechanism of action

Does anyone else think the stat that 98-99% of ovulations are suppressed by the pill needs to be cited or removed? It seems like a pretty definitive stat not to be cited. 152.121.16.5 16:51, 2 March 2007 (UTC)

Footnote number 45 claims 1.7% breakthrough ovulation when the pill is used perfectly. Lyrl Talk C 00:24, 3 March 2007 (UTC)
Yes, the stats and these inaccurate and misleading sentences should be removed:
"In women who take the pills correctly, ovulation is prevented in 98-99% of cycles.
Forgetting to take one or more pills increases ovulation rates;
one study found skipping two pills in a row resulted in ovulation in 29% of cycles."
The source:
Larimore & Stanford (2000). Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent PMID 10693729
cited for the stats, and on which this article's entire Mechanism of action section was inappropriately based,
is an exceptionally poor source --
an article by two Christian pro-life family practice physicians with no special expertise in hormonal contraception,
that is deceptive and misleading:
"While some smaller studies that evaluated small numbers of women for 6 or fewer cycles have reported breakthrough ovulation rates of near 0, studies that evaluated women for at least 6 cycles demonstrated ovulation rates ranging from 1.7% (Grimes et al. (1994) PMID 8272303) to 28.6% (Chowdhury, et al. (1980) PMID 7438752) per cycle."
Grimes "ovulation" rate: 1.7% = in 1 of 60 cycles (1 of 10 women over six cycles) had a single progesterone level > 3 ng/mL
Chowdhury "ovulation" rate: 28.6% = in 10 of 35 cycles (10 of 35 women in one cycle) had a single progesterone level > 4 ng/mL
(the 35 women intentionally skipped 2 consecutive pills during the cycle)
Grimes, et al.'s 13-year-old study in Los Angeles of functional ovarian cysts (not breakthrough ovulation) in multiphasic COCP users:
"Presumptive ovulation was defined as a serum progesterone level greater than 3 ng/mL.
Because we did not attempt to distinguish patients with lutenized unruptured follicles,
rates of ovulation based on serum progesterone should be considered maximum estimates"
Chowdhury, et al.'s 27-year-old study in Bombay of 'escape' "ovulation" is discussed in detail by four Christian pro-life Ob-Gyns in:
Crockett et al. (1999). Hormone Contraceptives Controversies and Clarifications (Appendix 3):
"But, is a single serum progesterone level of greater than 4 ng/mL sufficient evidence to prove ovulation?
Many authors have addressed this question. The answer is: 'Clearly, No'."
Crockett, et al. (1999). Hormone Contraceptives Controversies and Clarifications (Concerning the outcome of "on pill" ovulations):
In 25 peer-reviewed published studies of ovulation (indicated by ultrasound and serum chemical markers) in compliant users of current low-dose (30-35 µg ethinyl estradiol) and very-low-dose (20 µg ethinyl estradiol) COCPs:
In 18 studies including 3,799 cycles (avg. 211 cycles per study), there were 0 ovulations -- ovulation rate = 0% in 3,799 cycles
In 7 studies including 2,910 cycles (avg. 416 cycles per study), there were 8 ovulations -- ovulation rate = 0.27% in 2,910 cycles
In all 25 studies including 6,709 cycles (avg. 268 cycles per study), there were 8 ovulations -- ovulation rate = 0.12% in 6,709 cycles
= 1 ovulation every 839 cycles = 1 ovulation every 64 years
BC07 05:01, 16 July 2007 (UTC)

Side effects studies

This diff asked about the notability of a side effects study. I don't believe the study is notable for its own section, but I believe the high side effect rate is found is notable enough to be included in the article. The first sentence claims 60% of women taking the pill experience no side effects, and the "vast majority" of the rest are not bothered by side effects. (While this statement has three ref numbers next to it, only the University of New Mexico site seems to be authoritative as a reference.) But the French review and the Kinsey study both found that half of women who try the pill are so bothered by the side effects that they quit. I think that difference is important enough to be discussed in this article.

  • The 15-year-old French review article and and the small Kinsey Institute pilot study did not both find that "half of women who try the pill are so bothered by the side effects that they quit."
  • The French review article is outdated and the small Kinsey Institute pilot study of 79 women is not notable.
  • The undated anonymous UNM Student Health Center webpage statements:
    • About 40% of women who take birth-control pills will have side effects of one kind or another during the first three months of use.
    • The vast majority of women have only minor, transient side effects.
  • are in general agreement with clinical trials of COCPs and current medical reference textbooks on contraception.
    • Breakthrough bleeding or spotting (by far the the most common adverse effect) occurs in 30-50% of women during the first cycle, declining to under 10% by the third cycle.
  • The COCP and all other reversible methods of contraception (diaphragms, condoms, periodic abstinence, withdrawal, etc.) have relatively high one-year discontinuation rates, especially in adolescents, and those discontinuing the COCP frequently cite real or perceived side effects among their reasons for discontinuation.
BC07 04:41, 16 July 2007 (UTC)

I'm thinking of something like this for the intro to side effects section (and deleting the "discontinuation" section):

Different studies have found different risks of side effects. Some sources have found that the majority (about 60%) of women report no side effects at all, and the vast majority of those who do, have only minor effects.(UNM cite) Other studies have found that up to half of women who try the pill discontinue due to side effects.(French review & Kinsey cites)

Would that provide enough information? Is it accurately worded? Lyrl Talk C 03:59, 4 March 2007 (UTC)

For the most widely used prescription medications ever — and the most widely studied and intensively researched medicinal agents in history — many of the references in this Wikipedia article and its Side Effects section range from poor to totally inappropriate and misrepresent current clinical medical consensus:
Side effects
Weight
  • a French review article from 15 years ago PMID 1442247 citing:
    • results for a subgroup of adolescents from a survey 25 years ago
    • results from an unpublished study 18 years ago
  • a Hungarian study from 21 years ago comparing two high-estrogen-dose COCPs PMID 3588164
    • mentions only in passing, among other differences, an unquantified lesser weight gain with the lower-progestin-dose biphasic COCP
Sexuality
In this Wikipedia article — and other Wikipedia articles on contraception — I suggest using secondary sources such as:
as guides to current clinical medical consensus.
On weight gain and libido decrease, these sources say:

Weight gain

Weight (Weight gain)
  • Hatcher & Nelson (2004), p. 435-6:
    • Weight change
      • A placebo-controlled, randomized clinical trial has demonstrated that there is no difference in weight gain due to low-dose OC use. Similarly, a prospective trial of women using triphasic OCs with daily weight measurements for 4 months showed no change in mean weight at the end of the trial compared to baseline, although some weight fluctuations were noted during the cycle. Oral contraceptive use by adolescent women has been shown not to be associated with either weight gain or increased body fat in a 9-year study. In clinical trials, women who use OCs do not typically gain any more weight than women living in the United States typically gain in the same time interval.
      • Steadily gaining weight may be attributed to the nitrogen retention and increase in muscle mass stimulated by androgens. Although it is unlikely that the pill would be responsible for this type of weight gain, switching to a low androgenic pill (Ortho Tri-Cyclen, Ovcon-35, Modicon, Yasmin, etc.) may address that patient's concerns. Every woman should be encouraged to adopt a healthy diet and to exercise routinely to achieve and maintain a healthy weight.
  • Speroff & Darney (2005), p. 100:
    • Weight gain
      • The complaint of weight gain is frequently cited as a major problem with compliance. Yet, studies of low-dose preparations fail to demonstrate a significant weight gain with oral contraception, and no major differences among the various products. This is obviously a problem of perception, a conclusion supported by finding weight gain identical in treated and placebo groups. The clinician has to carefully reinforce the lack of association between low-dose oral contraceptives and weight gain and focus the patient on the real culprit: diet and lack of exercise. Most women gain a moderate amount of weight as they age, whether they take oral contraceptives or not.
  • Glasier (2006), p. 2999:
    • Minor side effects
      • Combined hormonal contraception is not associated with weight gain, although weight gain is a very common reason for discontinuation (73% of British women of all ages quoted weight gain as being a disadvantage of the pill). Most women gain weight with time. A study of weight changes among Brazilian women of reproductive age using nonhormonal contraception demonstrated a mean increase of 2.8 kg over 5 and 3.9 kg over 7 years.
  • Gallo et al. (2006). Combination contraceptives: effects on weight. Cochrane Database Syst Rev. PMID 16437470
    • Background: Weight gain is often considered a side effect of combination hormonal contraceptives, and many women and clinicians believe that an association exists. Concern about weight gain can limit the use of this highly effective method of contraception by deterring the initiation of its use and causing early discontinuation among users. However, a causal relationship between combination contraceptives and weight gain has not been established.
    • Objectives: The aim of the review was to evaluate the potential association between combination contraceptive use and changes in weight.
    • Main results: The three placebo-controlled, randomized trials did not find evidence supporting a causal association between combination oral contraceptives or a combination skin patch and weight gain. Most comparisons of different combination contraceptives showed no substantial difference in weight. In addition, discontinuation of combination contraceptives because of weight gain did not differ between groups where this was studied.
    • Authors' conclusions: Available evidence was insufficient to determine the effect of combination contraceptives on weight, but no large effect was evident.
  • Black et al. (2004). SOGC clinical practice guideline No. 143: Canadian contraception consensus Combined hormonal contraception. J Obstet Gynaecol Can PMID 15016334, p. 222:
    • Side-effects
      • Weight gain
        • Although weight gain is often thought to be a side-effect of the combined OC, placebo-controlled trials have failed to show any association between low-dose combined OCs and weight gain. Studies comparing the combined OC to other contraceptive methods have also failed to show a significant OC-associated weight gain.
  • RCOG FFPRHC (2007). FFPRHC clinical guidance: First prescription of combined oral contraception, p. 8:
    • Other relevant information
      • Weight gain
        • Clinicians should be aware that there is no evidence of additional weight gain due to COC use (Grade A recommendation - evidence based on randomised controlled trials).
        • Studies have suggested small increases in weight with COC use, however a Cochrane Review did not support a causal association between COC and additional weight gain.

Libido decrease

Sexuality (Libido decrease)
  • Hatcher & Nelson (2004), p. 403:
    • Other potential health benefits
      • Influence on sexual enjoyment. OC use may increase sexual pleasuring, either by increasing libido (less concern about pregnancy) or increasing lubrication. On the other hand, some OC users report decreased libido and more vaginal dryness.
  • Hatcher & Nelson (2004), p. 432:
    • Libido decrease
      • Though infrequent, decreased libido is occasionally a problem and may be the reason a woman seeks a different pill or a different contraceptive. When a patient notes a decrease in libido, also ask about depression as both symptoms may occur in the same patient. In some women, the pill alters vaginal secretions and decreases levels of free testosterone, both of which may decrease libido. An estrogen deficiency may decrease vaginal lubrication and make sexual intercourse less comfortable and occasionally painful. Consider the vaginal ring to increase lubrication. Even if the initiation of OCs is accompanied by a clear loss interest in sex or an inability to have orgasms, evaluate other potential causes of decreased libido or anorgasmia, including depression. Many women, however, may find more enjoyment from sex because the risk of pregnancy is reduced.
  • Hatcher & Nelson (2004), p. 434:
    • Vaginal discharge
      • Some women notice an increase in vaginal secretions with estrogen-containing contraceptives. These secretions are generally not an indication of infection. Women who use low OCs are not at any increased risk of developing uncomplicated candidal infections or bacterial vaginosis (BV). Reassurance is generally the only intervention needed once infection has been ruled out. Point out to the woman that these secretions are healthy and serve as a lubricant during coitus.
  • Speroff & Darney (2005), p. 72:
    • Other Metabolic Effects
      • Though infrequent, a reduction in libido is occasionally a problem and may be a cause for seeking an alternative method of contraception.
  • Glaiser (2006), p. 2999:
    • Minor Side Effects
      • The combined pill is associated with a variety of minor side effects probably common to all combined hormonal contraceptives regardless of delivery system. Nausea (rarely persistent), breakthrough bleeding, chloasma, and breast tenderness are all attributable to the steroid hormones. Mood change and loss of libido are but two of a list of common complaints less clearly related to the drugs.
  • Westhoff et al. (2007). Oral contraceptive discontinuation: do side effects matter? Am J Obstet Gynecol. PMID 17403440, p. 412.e6:
    • The association between OC use and libido has received attention in the popular press; our results that show essentially no change in sexual satisfaction among our OC users may help to deflate this emerging myth.
From the earliest days over half a century ago, development of the Pill has involved a trade-off between the most common adverse effect, breakthrough bleeding, versus most other adverse effects (breast tenderness, nausea, etc.) and rare but serious health effects (risk of venous thrombosis, stroke, myocardial infarction, etc.) as estrogen (and progestin) doses are reduced.
The current Side effects section of this article gives undue weight to three adverse effects: weight gain (Weight), libido decrease (Sexuality), and depression (Depression), of which the medical consensus is the COCP does not cause, or are infrequent and not clearly related to COCP use.
The residual "Other effects" subsection is a hodgepodge, listing:
  • vaginal discharge - a vague description - the estrogen in COCPs can cause leukorrhea
  • changes in menstrual flow - a vague description - COCPs reduce menstrual flow — an advantage — not an adverse effect (except where real or perceived amenorrhea causes concern about possible unintended pregnancy)
  • breakthrough bleeding - THE most common adverse effect of COCPs
  • nausea - an adverse effect of previous high-estrogen-dose COCPs; may be no more common with current low-dose COCPs than with placebos
  • vomiting - an adverse effect of previous high-estrogen-dose COCPs; may be no more common with current low-dose COCPs than with placebos
  • headaches - not an established adverse effect of COCPs
  • changes in the breasts - a vague description - COCPs can cause breast tenderness or mastalgia (an adverse effect) and breast enlargement (not always perceived as an adverse effect)
  • changes in blood pressure — a vague description - COCPs can cause increased blood pressure, but the effect is clinically insignificant with current low-dose COCPs
  • skin problems — a vague description - previous high-dose COCPs (like pregnancy) could cause melasma; this is now rare with current low-dose COCPs
  • skin improvements — a vague description - acne improves on current low-dose COCPs; 4 COCPs (with 4 different progestins) have approved indications for treatment of acne: Ortho Tri-Cyclen, Estrostep and Yaz in the U.S. and Alesse in Canada.
BC07 04:41, 16 July 2007 (UTC)

Category:Human reproduction

I propose removing this article from Category:Human reproduction. I have proposed narrowing the scope of that category at Category talk:Human reproduction. Please comment on the category talk page. Lyrl Talk C 14:59, 17 March 2007 (UTC)

Risk of depression

This is in response to this edit. I would normally discuss this on a user talk page rather than the main article talk, but the editor in question appears to be using a dynamic IP address, and so has no place I could leave a personal message.

The added information says there is no increase in risk of clinical depression. I would believe that any risk may be small, it is simply not true that there is no risk. I was diagnosed with clinical depression by my psychologist, who was shocked when I just showed up happy one day (I had quit taking Yasmin). I do not believe it was a psychosomatic reaction to being on hormonal birth control, because Ortho Tri-Cyclen did not have the same effect on me. (I believe both of these are low-dose pills.)

  • The sources do not say that COCP users have no risk of clinical depression, they say that COCP users have no increased risk (and may have a decreased risk) of clinical depression compared to women not using COCPs.
  • All currently available pills in general use are low-dose (< 50 µg ethinyl estradiol) pills.
  • Clinical depression while taking one COCP, but not while taking another COCP, is evidence against —not for—depression being a class effect of COCPs.
  • Your clinical depression while on Yasmin may have been pharmacological (mechanism unknown), psychological (psychosomatic), a coincidence, or a combination of the three.
BC07 04:49, 16 July 2007 (UTC)

Any idea why the studies referenced by the quoted medical sources found different results than Kulkarni's study?

  • Yes, because most of the hundreds of other studies of COCPs and depression were better designed than Kulkarni’s study.
  • Comparing self-report depression rating scales of 26 current-COCP-users to 32 not-current-COCP-users recruited by advertisement to take part in a study of depression in COCP users is about as likely to be unbiased and meaningful as the informal survey by Holi (a moderator of the Aphrodite Women’s Health website’s Contraception forum) of hormonal birth control side effects among over 540 women who discovered the survey in their search for information about depression and other negative side-effects they were already experiencing.
BC07 04:49, 16 July 2007 (UTC)

If it's been shown to be unlikely that lose-dose COCPs act on the serotonin and tryptophan systems, is it possible they contribute to depression by some other mechanism?

  • Yes, although they have not been shown to do so, it is possible that currently available low-dose COCP could contribute to—or prevent—depression by some other mechanism.
BC07 04:49, 16 July 2007 (UTC)

I would not want to add much to the length of the "depression" section in this article (I think it would unbalance the article). But it would be interesting if there was some short explanation that could be integrated into the section. Lyrl Talk C 01:25, 1 April 2007 (UTC)

I'm confused about what the depression section actually says at this point. It begins by saying there is no increased risk of depression and ends by saying there is an increased risk of depression from the progesterone? WTF? Kuronue 05:34, 19 April 2007 (UTC)
In response to these edits: If the sources present incorrect information, then let's find different sources, or not include that information at all. The information I cited from Hatcher about estrogen and progesterone was from a quote inserted by 68.255.19.121, "Both estrogen and progestin in high-dose pills interact with tryptophans and serotonin; however, low-dose pills have not been implicated in any of these complaints."" Yet the edit I've linked to changed the cite for this information to the aphrodite article. Did I misinterpret the quote that was provided?
  • Yes, you misinterpreted the quote. The 18th edition (2004) of Contraceptive Technology was correcting the 17th edition (1998) of Contraceptive Technology which incorrectly said (as had every edition since the 9th edition in 1978) that some cases of depression may be due to a vitamin B6 deficiency caused by the estrogen in COCPs and had suggested large doses of vitamin B6 as a possible treatment:
    • Hatcher & Guillebaud (1998, 17th ed.), p. 442-443:
      • Depression and Other Mood Changes
        • Accurately diagnosing the cause of depression in an OC user may be extremely difficult. The onset of depression may be quite insidious. It may be diagnosed by a person's acquaintances before it is recognized by the patient herself. OCs are more likely to improve depression and premenstrual irritability, although they may make these conditions worse. In some instances OCs produce a deficiency in pyridoxine (Vitamin B6).
    • Hatcher & Nelson (2004, 18th ed.), p. 433:
      • Mood swings, depression
        • Multiple studies have demonstrated no increase in the risk of clinical depression in women using OCs. Both estrogen and progestin in high-dose pills interact with tryptophans and serotonin; however, low-dose pills have not been implicated in any of these complaints. Women on OCs remain solidly within normal ranges for all vitamins and do not require vitamin B supplementation. Some women do report an increase in depressive symptoms, moodiness, and other emotional states while on OCs. This may represent an idiosyncratic response to hormones, which may warrant a decrease in hormone doses or pill cessation.
  • A few studies in the 1960s and early 1970s of high-estrogen-and-progestin-dose pills hypothesized that depression in some users might be due to effects on tryptophan metabolism and serotonin synthesis and metabolism; subsequent studies refuted the biochemical bases for these early hypotheses.PMID 3314189, PMID 8749595, PMID 9179457
BC07 04:49, 16 July 2007 (UTC)
The Yale article included interviews of "Yale gynecologist Ann Ross" and "Marjorie Green, a gynecologist" - which is why I used it as a source for doctors expressing that opinion - but the edit in question listed the articles as only an interview of college students with reference to Kulkarni's study.
  • In the Yale undergraduate student newspaper story (an unreliable source), neither gynecologist said they "believe that use of modern combined oral contraceptives does increase a woman's risk of developing depression."
BC07 04:49, 16 July 2007 (UTC)
The anonymous editor from addresses starting with 68 and 69 has shown an impressive amount of knowledge on other articles I've worked on, much more than myself, and I hope I'm open to learning from him or her. However, attacking sources within the article itself is not encyclopedic. I really hope we can discuss this on the talk page and wind up with a better article that makes both of us happy. Lyrl Talk C 23:16, 20 April 2007 (UTC)
The following sources for this subsection are either unreliable (the Aphrodite Women's Health website story and the Yale Daily News undergraduate student newspaper story) or not notable (Kulkarni et al.'s pilot study of 58 women) sources, and are inappropriate for this encyclopedia article:
Depression
  • an October 28, 2005 Aphrodite Women's Health.com Australian website story: Is The Pill Playing Havoc With Your Mental Health?
    • by a writer that the website notes has no health related credentials[24] (but was co-founder of Dateopedia.com)
    • the story cites:
      • a small March 2005 pilot study of 58 women by psychiatrist Jayashri Kulkarni at Monash University in Melbourne, Australia
      • later published as a one-page short report[25] PMID 16299641 in the November 2005 issue of Australian Family Physician, that noted several limitations of the pilot study:
        • the small sample size
        • the possibility of responder bias because participants were recruited by advertisement (for example perhaps the study attracted women with negative experiences of the pill)
        • the large variation in duration and type of combined oral contraceptive used
    • on August 4, 2006, when Willzter added this unreliable website story as an External link, Davidruben reverted its addition 19 minutes later, saying:
      • rv - extn link, its one writers opinion, poor research selection (one self-selecting reporting survey)
    • but this same unreliable website story has lasted almost four months as the primary reference for a Depression subsection since it was added on March 20, 2007 by Lyrl.
  • a February 12, 2007 Yale Daily News undergraduate student newspaper story: What to expect when you’re not expecting
    • based on interviews by the undergraduate student reporter of:
      • six of her girlfriends who were also seniors at Yale
      • a Yale University Health Services gynecologist
      • a gynecologist who is director of the Mt. Auburn Hospital Menopause and Sexual Medicine Center in Cambridge, Mass.
        • in the story, neither gynecologist said they "believe that use of modern combined oral contraceptives does increase a woman's risk of developing depression"
      • Australian psychiatrist Jayashri Kulkarni
On depression, reliable sources representing current clinical medical consensus say:
Depression
  • Hatcher & Nelson (2004, 18th ed.), p. 433:
    • Mood swings, depression
      • Multiple studies have demonstrated no increase in the risk of clinical depression in women using OCs. Both estrogen and progestin in high-dose pills interact with tryptophans and serotonin; however, low-dose pills have not been implicated in any of these complaints. Women on OCs remain solidly within normal ranges for all vitamins and do not require vitamin B supplementation. Some women do report an increase in depressive symptoms, moodiness, and other emotional states while on OCs. This may represent an idiosyncratic response to hormones, which may warrant a decrease in hormone doses or pill cessation. However, it is important to identify when these symptoms develop. If the symptoms appear just before the menses, then extended or continuous use of active pills may dampen the hormonal swings. If the patient desires withdrawal bleeding, restart her active pills each month on the first day of her menses. If there is concern about an underlying depressive or anxiety disorder, these conditions deserve explicit evaluation and treatment; cessation of hormonal contraceptives is not adequate therapy. Suicidal women need emergency treatment by specialists. Less acutely ill women may be managed locally with close follow-up.
  • Speroff & Darney (2005), p. 72:
    • Other Metabolic Effects
      • Mental depression is very rarely associated with oral contraceptives.
  • Speroff & Darney (2005), p. 107:
    • Summary: Oral Contraceptive Use and Medical Problems
      • Depression. Low-dose oral contraceptives have minimal, if any, impact on mood.
  • Glaiser (2006), p. 2999:
    • Minor Side Effects
      • The combined pill is associated with a variety of minor side effects probably common to all combined hormonal contraceptives regardless of delivery system. Nausea (rarely persistent), breakthrough bleeding, chloasma, and breast tenderness are all attributable to the steroid hormones. Mood change and loss of libido are but two of a list of common complaints less clearly related to the drugs.
  • ACOG (2006). ACOG practice bulletin. Use of hormonal contraception in women with coexisting medical conditions. Obstet Gynecol. PMID 16738183, p. 1463-4:
    • What are the effects of hormonal contraception in women with depressed mood?
      • A cohort from the fluoxetine clinical trials database of 1,698 combined oral contraceptive users and nonusers from 17 randomized double-blind, placebo-controlled clinical trials was evaluated. There was no significant effect of oral contraceptive use on depression, and oral contraceptive use did not modify the effectiveness of fluoxetine.
      • Data on use of hormonal contraceptives in women with depression are limited, but generally show no effect. Women with depressive disorders do not appear to experience worsening of symptoms with use of hormonal methods of contraception.
  • WHO (2004). Medical Eligibility Criteria for Contraceptive Use, 3rd ed. and
  • RCOG FFPRHC (2006). UK Medical Eligibility Criteria for Contraceptive Use
    • Depressive disorders = Category 1 - a condition for which there is no restriction for the use of the contraceptive method.
      • Clarification: The classification is based on data for women with selected depressive disorders. No data on bipolar disorder or postpartum depression were available. There is a potential for drug interactions between certain antidepressant medications and hormonal contraceptives.
      • Evidence: COC use did not increase depressive symptoms in women with depression compared to baseline or to non-users with depression.
  • Black et al. (2004). SOGC clinical practice guideline No. 143: Canadian contraception consensus Combined hormonal contraception. J Obstet Gynaecol Can PMID 15016334, p. 222:
    • Side-effects
      • Mood changes
        • Although women may report depression and mood changes while taking the combined OC, placebo-controlled trials have not demonstrated a significantly increased risk of mood changes in combined OC users compared to placebo users.
All seven sentences in the current Depression subsection (which does not warrant the emphasis of a separate subsection) are misleading and misrepresent current clinical medical consensus:
1. Low levels of serotonin, a neurotransmitter in the brain, have been linked to depression.
  • This statement is a misleading oversimplification.
2. High levels of estrogen, as in first-generation COCPs, and progestin, as in some progestin-only contraceptives, have been shown to promote the lowering of brain serotonin levels by increasing the concentration of a brain enzyme that reduces serotonin.
  • This statement is false; the source cited (Contraceptive Technology) does not say this.
3. Progestin-only contraceptives are known to worsen the condition of women who are already depressed.
  • This statement, in a website story by a writer with no health related credentials (an unreliable source), is false.
4. Current medical reference textbooks on contraception and major organizations such as the American ACOG, the WHO, and the United Kingdom's RCOG agree that current evidence indicates low-dose oral contraceptives are unlikely to increase the risk of depression, and unlikely to worsen the condition in women who are currently depressed.
  • Substituting the phrases "unlikely to increase the risk of" and "unlikely to worsen the condition in" weaken and misrepresent the statements in current medical reference textbooks on contraception and ACOG, RCOG FFPRHC, and WHO medical guidelines.
5. Contraceptive Technology states that low-dose COCPs have not been implicated in disruptions of serotonin or tryptophan.
  • This statement is misleading because the biological bases of the "disruptions of serotonin or tryptophan" hypothesized in some studies of high-dose pills 3 to 4 decades ago were refuted 2 to 3 decades ago. The "low-dose COCPs" referred to are COCPs with < 50 µg ethinyl estradiol—i.e. the only type of COCP in general use for the last several decades.
6. Some medical professionals, however, believe that use of modern combined oral contraceptives does increase a woman's risk of developing depression.
  • The undergraduate newspaper story (an unreliable source) does not say this.
7. A 2005 study by Professor Jayashri Kulkarni of Australia’s Monash University found the average pill user had an average depression rating scale score of 17.6, compared to 9.8 in the non-user group. (The women involved in the study were aged over 18, not pregnant or lactating, had no clinical history of depression and had not been on anti-depressant medication in the previous 12 months.)
  • This small, poorly designed pilot study is not notable.
BC07 04:49, 16 July 2007 (UTC)

What happens if a man takes the pill

What happens if a man takes the female contraception pill? Will you grow breasts? Also, if your on the pill are there any drugs that can interfere with the pill? I mean drugs like MDMA, LSD etc. —Preceding unsigned comment added by 19:08, 10 April 2007 (talk • contribs) 88.105.13.211

Not encyclopaedic to speculate on unused off-license usage. As for interference - yes some drugs do interfer with teh effectiveness of teh combined pill, thereby increasing the risk of contraceptive failure - see article re commonly accepted (but perhaps lacking in evidence) role for broad spectrum antibiotics. Also liver enzyme inducing drugs may increase metabolism of the hormones (some anti-eplipesy drugs and rifampicin) - such details though largely belong to prescribing formularies and medical textbooks, rather than this a general encyclopaedia. David Ruben Talk 23:46, 10 April 2007 (UTC)
It's not encyclopedic to *speculate*, but it would be encyclopedic to maybe briefly mention what the effects on a male would be if there were good sources to back it up. In fact I came to this page looking for an answer to the question too. --Krsont 00:25, 29 April 2007 (UTC)

Infobox risks

Revised from:

Incr. DVTs, strokes, breast cancer

to:

Increased DVTs;
Increased strokes & MIs if other risk factors present

References:

  • Hall JE (2005). "Infertility and Fertility Control" in Kasper, et al. (eds.) Harrison's Principles of Internal Medicine, 16th ed. ISBN 0-07-140235-7, p. 282:
Table 45-2. Oral Contraceptives: Contraindications and disease risks
II. Disease risks
A. Increased
1. Coronary heart disease—increased only in smokers > 35; no relation to progestin type
3. Venous thrombosis—relative risk ~4; markedly increased with factor V Leiden or prothrombin-gene mutations
4. Stroke—increased only in combination with hypertension; unclear relation to migraine headache
C. No effect
1. Breast cancer
  • Hatcher RA, Nelson A (2004). "Combined Hormonal Contraceptive Methods" in Hatcher et al. (eds.) Contraceptive Technology, 18th ed. ISBN 0-9664902-5-8, p. 404-5:
Health Complications
1. Myocardial infarction (MI). A pivotal U.S. study showed that low-dose OCs (< 50 mcg EE) do not significantly increase the risk of MI or stroke in healthy, non-smoking women.
2. Stroke in high-risk women. In 2002, a World Health Organization (WHO) panel found no significant increased risk of ischemic or hemorrhagic stroke among non-smoking women with no history of migraine headaches who use low-dose (≤ 35 mcg EE) OCs, as did a subsequent study.
  • Speroff L, Darney PD (2005). A Clinical Guide for Contraception, 4th ed. ISBN 0-7817-6488-2, p. 65:
Oral Contraceptives - Summary: Oral Contraceptives and Thrombosis
Low-dose oral contraceptives (less than 50 µg ethinyl estradiol) do not increase the risk of myocardial infarction or stroke in healthy, nonsmoking women, regardless of age.
  • Mishell DR Jr (2004). "Contraception" in Strauss & Barbieri (eds.) Yen & Jaffe's Reproductive Endocrinology, 5th ed. ISBN 0-7216-9546-9, pp. 913-5:
Oral Steroid Contraceptives - Cardiovascular Events - Stroke
The results of these recent epidemiologic studies indicate that use of low-dose estrogen-progestin OC formulations by nonsmoking women without risk factors for cardiovascular disease is not associated with an increased risk of MI or ischemic or hemorrhagic stroke. These data reveal that smoking is a risk factor for arterial, but not venous thrombosis.
Oral Steroid Contraceptives - Neoplastic Effects - Breast Cancer
Because estrogen stimulates the growth of breast tissue, there have been concerns that the high dose of exogenous estrogen in OCs could either initiate or promote breast cancer in humans. Accordingly, numerous epidemiologic studies have been published in which breast cancer risk among OC users has been determined.
This vast amount of epidemiologic data showing small or no changes in relative risk of breast cancer with OC use is very reassuring. It appears that the dose or type of either steroid, as well as duration of OC use, is not related to breast cancer risk. Because there is no relation between dose or duration of use of estrogen, it is unlikely that OCs initiate breast cancer. The collaborative analysis found that there was no significant increase in breast cancer risk with OC use at very young ages or use before a first birth.
Furthermore, the contraceptive steroids probably act to promote the growth or increase the chance of diagnosis of existing cancers because breast cancer has been thought to usually take many years to become clinically evident after the cancer is initiated. The epidemiologic findings are compatible with the hypothesis that OC use, like early first-term pregnancy, increases the risk of breast cancer diagnosis at a young age with no appreciable effect on lifetime risk of breast cancer and no change in risk during the perimenopausal years when the disease becomes most common.

69.208.186.119 22:06, 3 May 2007 (UTC)

"inhibit normal fertility"

An editor had explained their removal of this phrase at Talk:Oral contraceptive#"inhibit normal fertility". My reasons for wanting to include it in this article are somewhat different from why I had added it to the disambiguation page, so I'm replying in both places.

On this page, I find the phrase "The combined oral contraceptive pill... [is] taken by mouth to inhibit normal fertility" more informative to the reader than "The combined oral contraceptive pill... [is] taken by mouth to prevent conception". "Contraceptive" is in the name of the pill (and thus the article) - saying it prevents conception doesn't provide the reader with any new information. Saying that it inhibits fertility does provide such information.

To me, if a man puts on a condom, or a woman inserts a diaphragm, that person has not become infertile. They are still a fertile person, they are just using a barrier to prevent conception. If a woman observes her fertility signs (fertility awareness), she has not altered her fertility - just observed it. If a person chooses to be sexually abstinent, again, that doesn't mean (to my way of thinking) that they are infertile because they are abstinent. In contrast to these other ways of preventing conception, a woman taking COCPs is infertile. Easily reversible infertility, but infertility nonetheless. Which is neat, because then she doesn't have to mess with inconvenient and/or messy barriers or interpreting a fertility chart - she's just simply protected from pregnancy.

I don't think Wikipedia's introduction has to exactly mirror a definition found in a medical source. The introduction at condom, for example, says "It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner." I really doubt that explanation would be found in a medical definition, but I think it's a good, accurate, informative description useful to Wikipedia's readers. Similarly with the "inhibit normal fertility" in this article.

Regardless of the motivations of the editor that first added the phrase, it's been at the top of this high-visibility article for over two years, which demonstrates there is a community consensus to have it there. Consensus can change, of course, but in this case, I'm not currently convinced it should. LyrlTalk C 02:25, 13 August 2007 (UTC)

An editor had explained their removal of this phrase at Talk:Oral contraceptive#"inhibit normal fertility". My reasons for wanting to include it in this article are somewhat different from why I had added it to the disambiguation page, so I'm replying in both places.

On this page, I find the phrase "The combined oral contraceptive pill... [is] taken by mouth to inhibit normal fertility" more informative to the reader than "The combined oral contraceptive pill... [is] taken by mouth to prevent conception". "Contraceptive" is in the name of the pill (and thus the article) - saying it prevents conception doesn't provide the reader with any new information. Saying that it inhibits fertility does provide such information.

To me, if a man puts on a condom, or a woman inserts a diaphragm, that person has not become infertile. They are still a fertile person, they are just using a barrier to prevent conception. If a woman observes her fertility signs (fertility awareness), she has not altered her fertility - just observed it. If a person chooses to be sexually abstinent, again, that doesn't mean (to my way of thinking) that they are infertile because they are abstinent. In contrast to these other ways of preventing conception, a woman taking COCPs is infertile. Easily reversible infertility, but infertility nonetheless. Which is neat, because then she doesn't have to mess with inconvenient and/or messy barriers or interpreting a fertility chart - she's just simply protected from pregnancy.

I don't think Wikipedia's introduction has to exactly mirror a definition found in a medical source. The introduction at condom, for example, says "It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner." I really doubt that explanation would be found in a medical definition, but I think it's a good, accurate, informative description useful to Wikipedia's readers. Similarly with the "inhibit normal fertility" in this article.

Regardless of the motivations of the editor that first added the phrase, it's been at the top of this high-visibility article for over two years, which demonstrates there is a community consensus to have it there. Consensus can change, of course, but in this case, I'm not currently convinced it should. LyrlTalk C 02:25, 13 August 2007 (UTC)

Your unsourced personal opinions are unsourced personal opinions.

All contraceptive methods prevent fertility. Mishell DR Jr (2007). "Family Planning" in Katz, et al. (eds.) Comprehensive Gynecology, 5th ed. ISBN 0323029515, p. 275:

Reversible contraception is defined as the temporary prevention of fertility and includes all the currently available contraceptive methods except sterilization. Sterilization should be considered a permanent prevention of fertility even though both vasectomy and tubal interruption can usually be reversed by a meticulous surgical procedure. The reversible methods are also called active methods, and sterilization is also called a terminal method. A perfect method of contraception for all individuals is not currently available and probably will never be developed. Each of the various methods of contraception currently available has certain advantages and disadvantages. Therefore, when giving advice about contraception, the clinician should explain to the couple the advantages and disadvantages of each method, so they will be fully informed and can rationally choose the method most suitable for them. Because no reversible contraceptive method other than the condom has yet been developed for use by the male, the contraceptive provider generally counsels the female partner and should inform her if there are medical reasons that contraindicate the use of certain methods and offer her alternatives.

The unsourced phrase "inhibit normal fertility" is not used as part of a definition of oral contraceptives in any reliable source.
The phrase "inhibit normal fertility" and the word "chemicals" are POV terminology added by 214.13.4.151.

After warming up with some POV edits to the Abortion article, 214.13.4.151 turned their attention to the Oral contraceptive article.

214.13.4.151's first edit of the Oral contraceptive article was to change:

Female oral contraceptives, colloquially known as the Pill, are the most common form of pharmaceutical contraception, the prevention of unwanted pregnancy. They consist of a pill that women take daily and that contains doses of synthetic hormones (always a progestin and most often also an estrogen).

to:

Female oral contraceptives, colloquially known as the Pill, are the most common form of pharmaceutical contraception, taken primarily to disable an otherwise healthy female reproductive system, in order to avoid the natural consequence of sexual intercourse pregnancy. They consist of a pill that women take daily and that contains doses of synthetic (unorganic) hormones (almost always a progestin derived from horse urine, and most often also an estrogen).

Two days later, 214.13.4.151 began a series of POV edits to the opening sentence of the Oral contraceptive article.
A new opening sentence of the Oral contraceptive article had been hastily added by Tarquin over two years prior with an edit summary "rough fenition, please improve" (in response to an edit 12 minutes earlier by The Epopt, who apparently thought the article should begin with two inaccurate sentences about non-existent male oral contraceptives and a link to gossypol); this opening sentence was tweaked a year later by Viajero:

Oral contraceptives, colloquially known as the Pill, are the most common form of pharmaceutical contraception, the prevention of unwanted pregnancy.
Male oral contraceptives remain a subject of research and development, and are not available widely (if at all) to the public. Studies continue of various alternatives, such as gossypol.
Oral contraceptives are contraceptives which are taken orally, and act on the body's fertility by chemical means.
Oral contraceptives are contraceptives which are taken orally and inhibit the body's fertility by chemical means.
The combined oral contraceptive pill, often referred to as "the Pill", is a combination of an estrogen and progestogen taken by mouth to inhibit normal fertility.
The combined oral contraceptive pill, often referred to as "the Pill", is a combination of an estrogen (oestroge) and a progestin (progestogen), taken by mouth to prevent conception.
The Combined Oral Contraceptive Pill (COCP), often referred to as "the Pill", is a combination of an estrogen (oestrogen) and a progestin (progestogen), taken by mouth to inhibit normal fertility.

Medical definitions from WP:RS medical reference textbooks and medical dictionaries:

  • Mishell DR Jr (2007). "Family Planning" in Katz, et al. (eds.) Comprehensive Gynecology, 5th ed. ISBN 0323029515, p. 275:
    • KEY TERMS AND DEFINITIONS:
    • Oral Contraceptive Steroids (OCs) - Formulations of various synthetic progestins usually combined with a synthetic estrogen that are ingested orally to prevent conception. When the progestin is combined with an estrogen the formulation is called a combination oral contraceptive (COC). Oral progestin tablets without estrogen are called minipills.
    • Contraception - The prevention of pregnancy
  • Dorland's Illustrated Medical Dictionary, 31st ed. (2007). ISBN 141602364X
    • combined oral contraceptive - an oral agent that includes both an estrogen and a progestagen, which may be administered in either two or three different phases during each menstrual cycle.
    • oral contraceptive - a compound, usually hormonal, taken to block ovulation and prevent the occurrence of pregnancy.
    • contraceptive - an agent that diminishes the likelihood or prevents conception.
    • contraception - the prevention of conception or impregnation.
    • conception - an imprecise term denoting the formation of a viable zygote.
  • Black's Medical Dictionary, 41st ed. (2006). ISBN 0810857138
    • oral contraceptive - A contraceptive taken by mouth (see CONTRACEPTION). It comprises one or more synthetic female hormones, usually an oestrogen (see OESTROGENS), which blocks normal OVULATION, and a progestogen which influences the PITUITARY GLAND and thus blocks normal control of a woman's menstrual cycle (see MENSTRUATION). Progestogens also make the uterus less congenial for the fertilisation of an ovum by the sperm.
    • contraception - A means of avoiding pregnancy despite sexual activity. There is no ideal contraceptive, and the choice of method depends on balancing considerations of safety, effectiveness and acceptability. The best choice for any couple will depend on their ages and personal circumstances and may well vary with time. Contraceptive techniques can be classified in various ways, but one of the most useful is into 'barrier' and 'non-barrier' methods.
    • conception - Conception signifies the complex set of changes which occur in the OVUM and in the body of the mother at the beginning of pregnancy. The precise moment of pregnancy is that at which the male element, or spermatozoon, and the female element, or ovum, fuse together. Only one-third of these conceptions survive to birth, whilst 15 per cent are cut short by spontaneous abortion or stillbirth. The remainder - over one-half - are lost very early during pregnancy with trace.
  • Mosby's Dictionary of Medicine, Nursing & Health Professions, 7th ed. (2006). ISBN 0323035620
  • Mosby's Dictionary of Medicine, 7th ed. (2006). ISBN 0323039421
    • oral contraceptive - oral hormone medication for contraception. The two major sex hormones in females are estrogens and progestins. When synthetic forms of these hormones are taken, they inhibit the production of gonadotropin-releasing hormone by the hypothalamus, and therefore the pituitary does not secrete gonadotropins to stimulate follicular maturation and ovulation. Depending on the formulation, cyclical changes in the uterus, vagina and breasts may be similar to a normal menstrual cycle. Progestin-only oral contraceptives generally do not block ovulation. Instead they cause the cervical mucus to remain thick, which prevents the entry of sperm into the uterus and fallopian tubes. The pregnancy rate when oral contraceptives are correctly used is less than 0.2% a year.
    • contraceptive - any device or technique that prevents conception.
    • contraception - a process or technique for preventing pregnancy by means of a medication, device or method that blocks or alters one or more of the processes of reproduction in such a way that sexual union can occur without impregnation.
    • conception - 1) the beginning of pregnancy, usually taken to be the instant that a spermatozoon enters an ovum and forms a viable zygote. 2) the act or process of fertilization.
  • Stedman's Medical Dictionary, 28th ed. (2006). ISBN 0781733901
    • oral contraceptive (OC) - Any orally effective preparation designed to prevent conception.
    • combination oral contraceptive - a mixture of a steroid with progestational activity and an estrogen.
    • triphasic oral contraceptive - a birth control agent where hormones (i.e estrogen and progesterone) are given in three different phases.
    • contraceptive - An agent to prevent conception.
    • contraception - Prevention of fertilization or impregnation.
    • conception - Fertilization of oocyte by a sperm.
  • Stedman's Medical Dictionary for the Health Professions and Nursing, Illustrated, 5th ed. (2005). ISBN 0781744261
    • oral contraceptive - A medication taken by mouth designed to prevent conception.
    • contraceptive - An agent to prevent conception.
    • contraception - Prevention of conception or impregnation.
    • conception - Fertilization of the oocyte by a sperm to form a zygote.
  • Taber's Cyclopedic Medical Dictionary, 20th ed. (2005). ISBN 0803612079
    • oral contraceptive - Colloquially termed "the pill," consists of chemicals that are quite similar to natural hormones (estrogen or progesterone). They act by prevention of ovulation. When taken according to instructions, these pills are almost 100% effective.
    • contraceptive - Any process, device or method that prevents conception.
    • contraception - The prevention of conception.
    • conception - The onset of pregnancy marked by implantation of a fertilized ovum in the uterine wall.
  • Melloni's Illustrated Medical Dictionary, 4th ed. (2002). ISBN 185070094X
    • oral contraceptive - Any synthetic steroid that is similar to estrogen and progesterone (female hormones) and is taken orally at regular doses to alter a woman's hormonal balance, thereby inhibiting ovulation and preventing pregnancy. Popularly called birth control pill; the pill.
    • contraceptive - Any agent or device used for the prevention of conception.
    • contraception - The prevention of conception.
    • conception - Fertilization of an ovum by a spermatozoon.

BC07 03:20, 12 October 2007 (UTC)

Reply

I am really not sure what arguments BC07 is making here. They have put in capital letters that their position is supported by RELIABLE SOURCES, and implied that all my opinions are uninformed and therefore wrong. I consider myself in good company, then - from Gregory Pincus, "Experience with the use of progestinestrogen preparations as oral contraceptives indicates that they inhibit fertility" and he goes on to call these preparations "antifertility agents". The U.S. Patent Office also seems to have considered an application that states "The ability of the female sex steroids, namely estrogens and progesterone, to inhibit fertility in mammals has been known for many years." and that "Combination oral contraceptives are the most commonly used method for the hormonal suppression of fertility." I will readily acknowledge that this definition is less common than the self-referencing "oral contraceptives are contraceptives" definition, but I'm confused by the implication that my preferred definition is wrong.
BC07 and I also seem to have had a miscommunication on the definition of fertility. From Merriam Webster:
  • fertility
    • 1  : the quality or state of being fertile
    • 2  : the birthrate of a population
When I was commenting on fertility vs. infertility of a person and their choice of contraceptive, I had definition #1 in mind. BC07 responded by quoting an author that talks about contraceptives with respect to definition #2 (contraceptives lower the birthrate of the population using them). Google searches have many shortcomings, but one of their strengths is showing how words and phrases are most commonly used. Searches for condom "inhibit fertility" condom "suppress fertility" and condom "prevent fertility" each yield about 100 total results, a large majority of which use "inhibit fertility" and related terms to refer only to things that cause individuals to be subfertile despite barrier-free intercourse (definition #1), not referring to deliberate use of barrier methods. Using "inhibit fertility" and related terms to refer to contraceptives as a group (definition #2) appears to be a much less common usage - about 10% of hits using these searches.
As far as history, the "oral contraceptives are contraceptives" definition was only in place for three months of this article's history (the first year or so did not give a definition in the opening sentence). More than two years followed that included both the "are contraceptives" and the "inhibit fertility" definitions. The "are contraceptives" portion was then removed, and the article stayed like that for another two years. This pretty clearly supports that there is community consensus to include "inhibit fertility" in the opening sentence, and I'm confused by BC07 presenting the history as if it should support their position. LyrlTalk C 19:38, 13 October 2007 (UTC)

Weight parameter in infobox

There is a very common perception that hormonal contraceptives cause weight gain. One editor has produced quite an array of sources (including placebo-controlled trials) that conclude modern low-dose formulations, at least, have no effect on weight (see #Weight gain). Another editor has offered the theory that heavier women do not experience weight gain, but thin women are more likely to experience weight gain (see Talk:IntraUterine System#Literature Omissions About Verifiable Side Effects). Due to these conflicting opinions, it was suggested at Template talk:BirthControl infobox#Weight change entry that the infobox for hormonal contraceptions say "Weight - No proven effect". This acknowledges both the lack of authoritative studies showing weight gain as a side effect while not outright denying the common perception of women using the method (or, at least I hope that's what it would do).

I've posted messages at the other hormonal contraception articles asking for discussion here on this topic (it would be nice to treat this uniformly across these related articles, and this seems to be the highest visibility out of the bunch). So, how do others feel about changing the "Weight" parameter in the infobox to "No proven effect"? LyrlTalk C 21:26, 20 August 2007 (UTC)

  • That is a reasonable proposal, and well thought out, and I support it, barring any definitive studies that state otherwise.-Andrew c [talk] 22:14, 20 August 2007 (UTC)
  • Agree too :-) David Ruben Talk 22:55, 20 August 2007 (UTC)

Percy Julian

In February 2007, as part of its NOVA series, PBS aired the television program Forgotten Genius dramatizing the life of the chemist Percy Julian. For storytelling purposes, parts of the television program and its companion website are misleading and exaggerate the effects of some of Julian's work. One misconception fostered by the television program and its companion website is that Julian played a role in the history of the Pill when he did not.

Since February 2007, three anonymous users have added inaccurate and extraneous paragraphs about Percy Julian to the History section of this article 13 times:

  1. added 14:38 02 Feb 2007 by 141.149.208.54 --- removed 03:46 07 Feb 2007 by Richard Arthur Norton (1958- )
  2. added 13:02 07 Feb 2007 by 141.149.208.54 --- removed 21:04 07 Feb 2007 by Richard Arthur Norton (1958- )
  3. added 23:01 07 Feb 2007 by 141.149.208.54 --- removed 04:03 08 Feb 2007 by Richard Arthur Norton (1958- )
  4. added 16:50 08 Feb 2007 by 141.149.208.54 --- removed 01:39 12 Feb 2007 by Richard Arthur Norton (1958- )
  5. added 03:43 13 Feb 2007 by 141.149.208.54 --- removed 23:42 13 Feb 2007 by Lyrl
  6. added 23:59 14 Feb 2007 by 141.149.208.54 --- removed 02:42 31 Mar 2007 by Lynn4
  7. added 13:51 26 Aug 2007 by 71.123.29.191 ---- removed 18:48 26 Aug 2007 by Lynn4
  8. added 15:20 29 Aug 2007 by 71.182.123.65 ---- removed 17:29 29 Aug 2007 by Lynn4
  9. added 21:43 29 Aug 2007 by 71.182.123.65 ---- removed 21:44 29 Aug 2007 by Oxymoron83
  10. added 21:48 29 Aug 2007 by 71.182.123.65 ---- removed 21:48 29 Aug 2007 by Ohnoitsjamie
  11. added 21:52 29 Aug 2007 by 71.182.123.65 ---- removed 21:53 29 Aug 2007 by Ohnoitsjamie
  12. added 21:55 29 Aug 2007 by 71.182.123.65 ---- removed 21:55 29 Aug 2007 by Ugen64
  13. added 03:35 31 Aug 2007 by 71.182.123.65 ---- removed 07:15 02 Sep 2007 by Lynn4

The History section of this article is based on books about the history of the Pill, supplemented by journal articles to fill in details:

Oral contraceptives -- History
Asbell (1995) The Pill : a biography of the drug that changed the world
Marks (2001) Sexual chemistry : a history of the contraceptive pill
Watkins (1998) On the pill : a social history of oral contraceptives, 1950-1970
McLaughlin (1982) The pill, John Rock, and the church : the biography of a revolution
Djerassi (2001) This man's pill : reflections on the 50th birthday of the pill
Oral contraceptives
Vaughan (1970) The pill on trial
Birth control -- United States -- History
Tone (2001) Devices and desires : a history of contraceptives in America
Reed (1978) From private vice to public virtue : the birth control movement and American society since 1830
Hormones
Maisel (1965) The hormone quest
Steroid drugs
Applezweig (1962) Steroid drugs
Steroid hormone industry
Gereffi (1983) The pharmaceutical industry and dependency in the Third World
Contraception
Speroff & Darney (2005) A clinical guide for contraception, 4th ed.

All of the above books on the history of the Pill devote at least a few paragraphs, and sometimes entire chapters, to Russell Marker and Syntex because of their important roles in the history of the Pill.
None of the books on the history of the Pill even mention Percy Julian because he did not play a role in the history of the Pill.

Three of the above books are devoted entirely to the history of the Pill: Asbell (1995), Marks (2001), and Vaughan (1970).

In Asbell (1995), the first two pages of the first chapter and the entire sixth chapter are about Russell Marker.
Russell Marker is the first person mentioned in the book.
In Marks (2001), the second page of the Introduction and a substantial part of the third chapter are about Russell Marker.
Russell Marker is the first person mentioned in the book.
In Vaughan (1970), most of the first chapter is about Russell Marker.
Russell Marker is the fourth person mentioned in the book (after Sanger, Pincus, and McCormick).

Marks (2001) page 2:

Challenging previous histories, which have championed the pill as a North American product that fuelled the sexual revolution, this book suggests that its roots and the effects of its adoption were much more diverse and can only be understood within a wider international framework. As Chapters 2 and 3 suggest, much of its chemical evolution lies in the rise of the lucrative sex hormone industry in Europe during the early twentieth century, and the migration of refugee scientists to the American continent in the wake of fascism and the Second World War. Born out of the race to find easier and cheaper methods of making sex hormones, and the discovery of the anti-arthritic drug cortisone in 1949, the pill emerged from the research of an ingenious yet fickle chemist called Russell Marker (1902-95) on the Dioscorea plant, a wild yam vine which clings to the trees in the mountains of southern Mexico.

Lynn4 07:08, 2 September 2007 (UTC)